March2019

March2019

You’ve probably seen all the news reports and read the paper about how bad sitting all day at work is for you?

But is it really that bad?

Short answer YES!

Let’s break it down, you wake up, sit down to have breakfast, make your way to work probably sitting in a car/ train or bus, then sit at work, even have lunch sitting down, then travel home and sit on the couch. So all in all we are looking at 12-15hours of sitting, every day!

The human body was made to move constantly throughout the day, and you sit for more than half of it, and lie down for 6-8hours, making you sedentary for approximately 20 hours a day. Prolonged sitting has been linked to numerous chronic diseases such as diabetes and heart disease. A person who sits all day may find weight gain to be an issue. This is because the body slows down in a seated/ resting position, so does metabolism, so calories are burnt at a far slower rate.

But how do I stop sitting all day?

We have to be realistic as most people work at a desk and unless you’re going to change your career path it’s difficult to change your seating habits but we have a few tips that will hopefully get you more active.

Keep track of how long you sit each day, this total might surprise you.

Ask your work for a standing desk, recent research has indicated standing has far more favourable metabolic effects than sitting

Commence a walking program start with walking 20mins before breakfast, at lunch and after dinner. Build this into your routine then increase the speed, distance and time that you walk

Start an exercise program  The World Health Organisation (WHO) recommends 150minutes of physical exercises a week, combine this with a walking program and before you know it you will be feeling better, losing weight and doing more than 150minutes.

At work take regular breaks to stand and walk around, I’m sure you might even notice your productivity improve

When watching tv at night, get up during the ad breaks and stand just to break the cycle of constant sitting after work

The first muscle is the commonly known gastrocnemius (the large bulkier muscle) in your lower limb.

The second muscle is your soleus.

Both muscles are extremely important for ankle stability and particularly responsible for pointing your ankle downward. Therefore, your soleus is a vital muscle for walking, running and balance.

The soleus muscle is often overlooked by the general population due to it being a smaller flatter muscle hidden behind your larger gastrocnemius muscle. Your soleus runs from just below your knee to your heel/Achilles tendon, behind your leg. It is made up of predominantly slow twitch muscle fibres and therefore makes it more resistant to fatigue.

Why is this muscle so important in runners?

When you run, your body has to support up to 3-8x our own body weight! Both of your calf muscles have a very important role in walking and running and in particular our soleus. This particular muscle works to flex the foot so that the toes point downwards (plantar flexion) and further plays an important role in ankle stability and standing posture to prevent you from falling forward.

The soleus muscle does not have the power that our larger calf muscle (gastrocnemius) has, due to it primarily made up of slow twitch fibres and therefore this muscle is importance for endurance. The soleus bears a lot of load during running, much more than the larger gastrocnemius muscle and is often called the skeletal-muscle pump because of its ability to pump deoxygenated blood back from your legs to your heart.

For runners the soleus:

The soleus drives you forward during running and walking

Bears most of the load from running

Is made up of slow twitch fibres and therefor very resistant to fatigue

How do I make my soleus stronger to assist my running?

The best way to activate your soleus involves plantar flexion or pointing your toes downward, while your knees are in a bent (preferably at or around 90 degrees) position. Bent knee’s during heel raises targets the soleus. For some great exercises to target your soleus be sure to visit Enhance Physiotherapy and speak to your Physiotherapist.

Enhance Physiotherapy Running Assessment

Our running assessment will evaluate your running form to identify muscle imbalances along with areas of your running technique that you can correct in order to improve performance and reduce the risk of injury.

Last week we posted a video on our Facebook page of an incredible 84 year old woman who is completing strength training exercises as part of her rehab program following muscle tears in the shoulder.

Her initial shoulder injury can be attributed to frailty – a condition of weakness that we usually associate with elderly people.

Research (systematic review) has looked at the most effective intervention for delaying and reversing frailty once it has been identified.

Different types of interventions looked at including physical activity, health education, nutrition supplementation, home visits, hormone supplementation, and counselling

In over 900 studies and over 15,000 participants the most effective intervention found for delaying or reversing frailty was a combination of strength training and protein supplementation.

So at the end of the day, age is no excuse to be missing out on strength training! If anything – this research highlights how important it is as we get older to stay strong and avoid or delay the impact of frailty.

A gluteal tendinopathy is characterised by pain on the outside of the hip. The main cause of a gluteal tendinopathy is thought to be too much activity including different activities that the body is usually unaccustomed to or too little activity

Other risk factorsfor a gluteal tendinopathy include:

Gender: women more likely than men

Age: more likely in those greater than 40 years of age

History of low back pain

Pelvis and hip shape

Higher body mass index

People who have a gluteal tendinopathy often report pain and discomfort (aggravation) associated with the following tasks and activities:

Crossing legs

Side-lying

Steps/stairs

Walking

Sitting to standing

Hip/back stretching exercises

Touching side of hip

The main features of managementfor a gluteal tendinopathy include:

Load management

Exercise therapy

Modifying risk factors

Our team at Enhance Physiotherapy are skilled in accurately assessing, diagnosing and managing individuals experiencing a gluteal tendinopathy.

Groin pain in athletes is an umbrella term used to describe pain on the inside of the thigh often associated with sporting activities that involve kicking, skating and change of direction (Thorborg et al., 2018).

The exact cause of groin pain often falls under one of the following categories:

Adductor related groin pain

Iliopsoas related groin pain

Inguinal related groin pain

Pubic related groin pain

Hip related groin pain

Other causes of groin pain

Tests including range of movement, neuromuscular control, muscle strength, palpation, functional tasks, balance, orthopaedic tests and occasionally diagnostic imaging are utilised by healthcare professionals to assess and differentiate between the various known causes of groin pain (Thorborg et al., 2018).

Management of groin pain in athletes often involves:

Muscle strengthening

Supervised active training programs

Load management

Functional re-training

Motor control

Manual therapy

Our team at Enhance Physiotherapy are experienced in assessing and managing groin pain in athletes ensuring you return to sport in a safe and timely manner.

We often get asked “why should I see a physiotherapist”. Physiotherapists are allied health professionals that are skilled at assessing, diagnosing and treating a range of injuries and medical conditions, from lower back pain and knee pain to headaches and nerve symptoms. We can also help with exercise goals, sports performance and recovering from surgery or work related injuries.

So what can a physiotherapist offer?

Physiotherapists spend time getting to understand you as a person. Asking what you do for work, what hobbies or sport do you enjoy, what do you do at home. This provides us a holistic view of your life. They take the time to complete a thorough assessment of your injury to determine a diagnosis and develop a treatment plan with the aim of long term recovery and prevention of future episodes. We pride ourselves on looking at the individual and their goals, not just the injury.

What might treatment include?

Depending upon the injury or condition treatment will vary. Hands on treatments such as massage, dry needling and joint mobilisation may be used in the early stages along with other modalities such as taping and bracing. Exercise is almost always involved to restore movement, strength and function. In addition, physiotherapists are passionate about empowering people to improve their health and take control of their recovery. As a result, tools to support self-management and education is also a common part of your treatment plan.

How do I go about seeing a physiotherapist?

You do not need a referral from your GP to see a physiotherapist. You can call or book online to make a time with any of our experienced practitioners to find out how we can help improve your pain and better your health. Rebates from private health insurance are available.

With term 1 definitely into full swing, it is a good time to review your children’s backpacks to ensure healthy wearing habits are forming for the new school year. I can remember back to when I was in high school in particular, where it was “uncool” if we didn’t slug our backpacks around on only one shoulder. These backpacks, which often had minimal support features that bags these days have, would be weighted down with numerous folders and text books for the day’s learning.

To ensure our children form the best school bag carrying habits, recommendations from the Australian Physiotherapy Association’s Paediatric Group Chair, Julianne Pegler are:

Choose a backpack with wide shoulder straps that sit well on the shoulder.

Ensure waist and chest straps help transfer some of the load to the hips and pelvis.

A padded back-support will allow the pack to fit ‘snugly’ on the back.

Ensure the backpack fits the child; don’t buy a big pack to ‘grow’ into—the pack should not extend higher than the child’s shoulders when sitting.

Be aware that moderately weighted backpacks are not detrimental to kids’ back health.

Avoid swinging backpacks around.

The two key factors regarding the transfer of weight from the contents of the backpack to the wearer are

how much weight (downward force) is placed on the wearer’s shoulders/back/pelvis, and

how much leverage (rotational force) does the backpack place on the wearer’s pelvis/back/shoulders.

Whilst we can get backpacks that have support features through the backrest of the bag and great shoulder/waist straps, these are of little use if the wearer does not wear the backpack correctly (as I did for 6 of the best years in high school). When our kids start to get into years that require the carrying of hefty text books, look for backpacks that have a waist strap, as this will greatly assist in transferring the weight directly to the pelvis and reduce the leverage forces on the spine. A further tip is to pack heavier items closer to the backrest to reduce the leverage across the shoulder straps.

To know whether your child’s backpack is too heavy, look for these signs:

It’s difficult for your child to put on or take off their backpack.

Your child reports having pain or tingling or numbness in arms from wearing it.

By keeping these things in mind and encouraging our children to wear their backpacks correctly, we can reduce the strains and pains that may occur from poorly fitting backpacks or poorly carried loads.

Your posture is one of the first things other people notice about you and can affect so much more in your life than just spinal health. Healthy posture has been linked to better respiratory health and has even been shown to affect your confidence. In this blog, we explore a few other surprising facts about posture.

Ideal posture doesn’t mean having a straight back.

Many people think having good posture means standing as straight as possible with your shoulders pulled back. This is actually a relatively unnatural posture and requires a lot of energy to maintain. Ideal posture, where the spine rests in it’s most comfortable and strongest position, is where the neck has a gentle curve backwards, the thoracic is curved gently forwards and the lower back curves back again. These curves create an elongated ‘S’ shape and can be seen when viewing a person from side on.

There are four common postural patterns other than ‘ideal posture’.

For those who don’t have ideal posture, four common variations are seen, these are; kyphosis (excessive curve of the thoracic region), lordosis (excessive curve of the lower back), flat back (loss of the normal spinal curves) and sway back (where the pelvis is pushed in front of your centre of gravity and the upper body leans back to compensate).

Each of these postures is often accompanied by a typical pattern of joint and muscle stiffness that can lead to pain and injury. Your physiotherapist is able to assess your posture and identify any ways this may be contributing to your pain. They can also help you to change your posture with strategies to increase spinal mobility and strength.

Regular movement is just as important as your posture.

While ideal posture has been shown to reduce the amount of stress and tension found in the spinal muscles, holding yourself rigidly in one position is also not healthy. Ideally, our spines will be flexible and able to move through their full range without pain or stiffness. Regular movement is the key to healthy joints, including the spine. If you finding yourself sitting or standing for long periods, try to find time to stretch as well as working on your posture.

Personality type has been linked to postural patterns.

A study by S. Guimond and others in 2014 showed a surprising link between personality type and posture. They found that extraverted personalities were much more likely have an ‘ideal posture’ or excessive spinal curves than Introverted personalities and introverted personalities were more likely to have ‘flat’ or ‘sway back’ postures. They were unable to determine if personality influenced posture, vice versa or there was a hidden third factor such as pain.

We often see patients in the clinic who work physically demanding jobs, but this doesn’t always seem to correlate with their physical health and fitness. I guess if makes sense, if that were the case, why weren’t all farmers, mechanics or builders ripped and toned?

Holtermann et al have looked into the difference between ‘Occupational Physical Activity’ versus ‘Leisure Time Physical Activity’ and why in fact they did not produce the same results. Manual, labour intensive jobs often involve sustained low to moderate intensity, long duration activities. This results in prolonged elevated heart rate and prolonged elevated blood pressure (both increase the risk of CVD). In comparison – formal exercise see’s heart rate and blood pressure rise but afterwards it returns to a resting rate.

Occupational physical activity is usually performed over longer periods of time, say 8 or more hours a day, 5 or more days a week. The remaining time, is insufficient for proper recovery of the body and body systems. It’s essentially the same as athletes ‘overtraining’. And overtraining that reoccurs week after week. This results in a sustained increase in inflammatory markers without that sufficient recovery, which has also been associated with increased risk of CVD.

Occupational activity also usually involves performing poor techniques in awkward postures, with the addition of psychosocial stressors and uncontrolled environmental situations – extreme heat/cold in full PPE. With voluntary exercise, people usually have some form of control environmentally – and have control over attire. Movements performed are also dynamic, targeted and specific tasks.

Enhance Physiotherapy are experts in creating strength and exercise programs to suit you and your goals!

A ring of flexible, fibrous connective tissue, known as the glenohumeral labrum, surrounds the shoulder joint. This labrum increases the stability of the shoulder while allowing for the required flexibility of one of the bodies’ most sophisticated joints. One well-known muscle of the arm, the biceps, has an attachment directly into the labrum and is a common site of injury. A tear of the labrum can occur in many locations, however the most common is at the point where the biceps tendon attaches to the labrum. Usually, this tear follows a typical pattern and is referred to as a superior labrum tear, anterior to posterior (SLAP tear).

What causes it?

SLAP tears can be caused by trauma such as a fall onto an outstretched hand or a dislocated shoulder. Tears can also develop over time with repeated throwing actions or overhead activities as the labrum is weakened and eventually injured. Traumatic tears are more likely to be symptomatic than tears that develop slowly.

What are the symptoms?

As mentioned, SLAP tears can occur suddenly, through trauma or develop slowly through repeated stress. Often if the injury develops over time, patients can be unaware they have sustained a tear and the injury doesn’t have a significant impact on their pain or function. Preexisting SLAP tears can however, place more tension on the long head of biceps tendon, leading to overuse disorders as a secondary complication.

When the tear occurs through a sudden action or trauma, symptoms can be more marked. Sufferers often notice pain deep in the shoulder joint with overhead shoulder movements, a feeling of weakness, loss of power and/or accuracy with throwing activities. Some people may notice a popping or clicking sensation and occasionally the shoulder may give way. In severe tears, the shoulder might feel unstable and even be at increased risk of dislocation.

How can physiotherapy help?

Your physiotherapist is able to help diagnose a suspected SLAP tear and send you for further imaging if needed. SLAP tears are often graded by severity from I to IV as a way to guide treatment. Physiotherapy is usually recommended as a trial for all tears before considering surgical repair and in many cases can effectively help patients return to their previous activities, symptom-free.

If physiotherapy is unsuccessful, surgical repair with a full rehabilitation program is recommended. Surgery will usually either repair the tear or reattach the biceps tendon to the humerus. Following surgery, a period of rest in a sling is required before rehabilitation can begin.